Provider Demographics
NPI:1528466018
Name:NEWHOUSE, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NEWHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 W PROSPECT AVE
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8798
Mailing Address - Country:US
Mailing Address - Phone:920-729-7105
Mailing Address - Fax:
Practice Address - Street 1:3913 W PROSPECT AVE
Practice Address - Street 2:SUITE LL1
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-8798
Practice Address - Country:US
Practice Address - Phone:920-729-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12759-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist